title: Complication of a closed Colles-fracture: necrotising fasciitis with lethal outcome. A case report.
abstract: We report a case of a 77-year-old female patient who died 4 days after a closed colles-fracture of the right wrist because of secondary emerged necrotising fasciitis. At the time of visiting our emergency department, the patient reports about untypical pain and progressive swelling of the entire right arm 3 days following a fall onto the outstretched hand where she sustained a closed distal radius fracture. Within 6 h, the patient developed hypotension and fever leading to cardiac and respiratory failure. The emergent-induced diagnostic presented a severe septic situation in the laboratory examination of the blood samples, an apparent before unknown diabetes mellitus and an unknown bronchial carcinoma with part of post-stenosis pneumonia of the right lung. After initial CPR and stabilisation, the patient underwent an urgent and aggressive surgical debridement with fasciotomies of the muscle compartments of the entire right upper extremity. The microbiological investigation of the intraoperative taken specimens presented plentiful group-A-beta-haemolytic streptococcus. Despite a broad spectrum intravenous antibiotic therapy, intensive care support and a second look operation 12 h later with exarticulation of the right arm in the shoulder joint, the patient died of septic shock and multiorgan failure 34 h after admission.
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany. p.a.weidle@web.de
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Weidle
authors.forename: Jochen
authors.initials: J
authors.lastname: Brankamp
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dedy
authors.forename: Christoph
authors.initials: C
authors.lastname: Haenisch
authors.forename: Joachim
authors.initials: J
authors.lastname: Windolf
authors.forename: Michael
authors.initials: M
authors.lastname: Jonas
mesh_terms: D000368:Aged; D003100:Colles' Fracture / Q000150:complications* / Q000628:therapy; D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D005596:Fractures, Closed / Q000150:complications* / Q000628:therapy; D006801:Humans; D013290:Streptococcal Infections / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D013297:Streptococcus pyogenes